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psychogenic factor in the determination of the psy- chotic symptoms. Anotlier important point must be accentuated that dementia prsecox usually develops in a peculiar type of personality known as "shut in" (Hoch). No niatter what theory may be accepted, the fact remains that this disease is progressive in its nature, and the prognostic outlook is invariably grave as far cheap premarin as mental life is concerned. However, remissions of varying duration may occur, and there premarin price is a group of cases in which deterioration remains stationary and the psychotic content is not pro- gressive, and generic conjugated estrogens such patients are able to get along outside of a hospital for the insane, provided that they are placed in a simple environment under proper supervision. This is also true of cases of the simple deteriorating form. Although the psychanalytic method in dementia pryecox offers great aid to our knowledge of under- standing the various psychotic manifestations with their underlying mechanisms, nevertheless the con- tention of some that in its incipiency the progress of the disease can be arrested by means of psych- analysis has not been borne out by our experience. So far, the cases reported are not convincing, and furthermore the diagnosis of dementia pn-ecox is questioned. It should be borne in mind that in de- mentia prsecox the infantile fixations are not of such plasticity as one meets in psychoneuroses, and fur- thermore the volitional disturbances with disintegra- tion of personality do not make this disease amen- able to this form of psychotherapy. June 5, I9"5-] KARPAS: PROGNOSIS IN MENTAL buy conjugated estrogens online DISILASE premarin tablets 1 149 The paranoiac group forms another class of malig- nant psychoses, and by reason of the progressive systematized delusions and the impairment of the premarin cost judgment faculty, the patients do not yield to recti- fication and readjustment. It is interesting to note that for many years some of these patients are able to be at large, but sooner or later they come in con- flict with the law and commitment becomes impera- tive. True paranoia is rarely seen in the hospitals; some of the paraphrenics may likewise be able to adapt themselves to a less complicated environment, but as soon as their delusions of persecution and hallucinations become intense, institutional care be- comes indispensable. None of these patients shows any deterioration in memory, but judgment is mark- edly affected. They may live for years, and death usually occurs from some intercurrent disease. Of the benign psychoses the manic depressive group is the most important. This is an acute emo- tional disturbance, which may express itself in a de- pression or excitement purchase premarin online or in purchase premarin a mixed phase. It is recurrent premarin online in nature, and heredity plays an important role. The attack as a rule is sudden in onset and the recovery is complete without defect symptoms. The manic excitement varies in duration, lasting from a few days to several years ; the average dura- tion is from buy cheap premarin three to six months. The outcome is usually favorable; however, death may result from pure exhaustion ; particularly is this true of the first attack. It is well to tell the patient's relatives that should no somatic complications set in, the recovery w^ill be complete. The course of the depressed form is rather pro- tracted, especially in advanced life. The attack lasts longer than in the manic form. The average dura- tion is about four or six months, buy premarin online and in some in- stances the upset may continue for several years. Physical premarin mg complications may occur ; death may result from inanition, and suicidal attacks are not infre- quent. The buy premarin course and duration of the mixed form of manic depressive insanity is relatively longer than the manic and depressed phases ; the average dura- tion is about six or nine months. However, there are cases which last only a fortnight, and again the duration may be from buy conjugated estrogens one to five years. In 1907, Dreyfus called attention to the fact that involution melancholia is closely related to the manic depressive group, and identified it with the mixed form; and later his contention received Kraepelin's recognition. In this group of cases, the outcome is favorable, provided that it is not complicated by arteriosclerosis. In a small per- centage of cases dementia may be developed as a result of arteriosclerotic brain affection. In some cases the outcome is decidedly fatal, due to marked agitation and somatic complication. Briefly stated, in all forms of manic depressive insanity the upset has a favorable outcome, and indeed without mental deterioration. How- ever, in a very large majority of instances, the at- tack may recur. In rendering a prognosis generic premarin of such cases, this point should be borne in mind, and the patient's relatives should be acquainted with this fact. Furthermore, every possible effort should be made to ascertain all the manifest causes that pre- cipitated the psychosis, and in such a way that special adaptation for individual cases might become necessary, with the order premarin online aim of prolonging or even pre- venting the appearance of another attack. In simple depressions and in hysterical psychosis, the outcome is very favorable, and under proper psychotherapy a recurrence may be prevented. III. TOXIC. This group of mental disorders order premarin is brought about

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